Lecture 9: Upper Extremity

Question 1

what are the 2 main types of strokes

Answer 1

Ischemic

Hemorrhagic

Question 2

what are the two types of ischemic strokes

Answer 2

Thrombosis: Blood clot

Embolism: Dislodged platelets, cholesterol, or other material that travels in bloodstream and blocks a vessel

Question 3

what is a Hemorrhagic stroke

Answer 3

rupture of blood vessels
* Aneurysm

Question 4

effects of a stroke are determined by what

Answer 4

the location of the stroke

Question 5

what part of the brain does the anterior cerebral artery supply blood to

Answer 5

front part of brain

Question 6

what part of the brain does the middle cerebral artery supply blood to

Answer 6

lateral part of brain

Question 7

what part of the brain does the posterior cerebral artery supply blood to

Answer 7

posterior part of brain

Question 8

what are the 4 main symptoms of an anterior cerebral stroke

Answer 8

contralateral sensorimotor deficit of foot and leg

arm paresis

gait ataxia

perservation

Question 9

what are the 4 main symptoms of a middle cerebral stroke

Answer 9

contralateral sensorimotor deficit of face, arm, leg

contralateral semi-spatial neglect or inattention

aphasia

dysarthria

Question 10

what are the 6 symptoms of a posterior cerebral stroke

Answer 10

nausea and vomiting

vertigo

ataxia

weakness

sensory loss

dysarthria

Question 11

what joint is the most susceptible to changes post stroke and why

Answer 11

glenohumeral joint

it relies on muscles and tendons to keep it in place

Question 12

what 4 things causes static stability of the shoulder joint

Answer 12

muscles

joint capsule

joint geometry

ligaments

Question 13

which 2 groups of muscles create the dynamic stability of the shoulder

Answer 13

Scapulo-humeral Muscles (Rotator Cuff & Deltoid)
o Maintains the humeral head in the glenoid fossa

Scapulo-thoracic Muscles (Serratus Anterior)
o Moves scapula on rib cage (important for reach)

Question 14

dynamic stability of the shoulder relies on which 3 things

Answer 14

Optimal alignment of the scapula

Correct Glenohumeral orientation

Length-tension relationship of muscles

Question 15

Arm elevation requires which 2 types of motion

Answer 15

Scapulohumeral motion

Scapulothoracic motion

Question 16

what is the purpose of Scapulothoracic motion

Answer 16

This significantly decrease the shearing effect between the humeral head and the glenoid

Question 17

what is the purpose of Scapulohumeral motion

Answer 17

This allows the glenoid fossa to be positioned directly under the humeral head during the end ranges of abduction to increase joint stability

Question 18

what are the 3 Prime movers for shoulder flexion

Answer 18

0 degrees > 15 = supraspinatous

15 degrees > 90 = deltoid

90 = serratus anterior

Question 19

when is scapular rotation the greatest

Answer 19

between 80 - 140°

Question 20

how can a stroke cause shoulder subluxation

Answer 20

muscles supporting the shoulder are not ‘working properly

This causes INSTABILITY in the glenohumeral joint

Question 21

what is the most common type of subluxation in stroke patients

Answer 21

inferior subluxation

Question 22

what does an inferior subluxation look like

Answer 22

lateral trunk flexion to weak side

scapula is downwardly rotated

Question 23

which stroke is the most likely to cause hand and arm deficits

Answer 23

middle cerebral artery strokes

Question 24

What 3 post-stroke impairments directly impact the upper extremity?

Answer 24

Impaired motor control (upper extremity AND TRUNK)

impaired sensory perception

shoulder pain

Question 25

what is typical posture post stroke of head

Answer 25

lateral flexed toward involved side, rotation away from involved side

Question 26

what is typical posture post stroke of the upper extremity

Answer 26

scapular depression and retraction,

shoulder adduction and internal rotation,

Upper extremity flexion

forearm pronation,

Question 27

what is typical posture post stroke of the trunk

Answer 27

posterior pelvic tilt, possible rotation, lateral flexion toward involved side

Question 28

what is the continuum of muscle tone

Answer 28

flaccidity

hypotonia

normal

spasticity

rigidity

Question 29

is an increase in muscle tone always bad?

Answer 29

no. we naturally have temporary increases of muscle tone when we’re in pain or nervous

Question 30

what is spasticity

Answer 30

velocity-dependent increase in tonic stretch reflexes

tight one direction, moves quickly back in other direction

Question 30

what is rigidity

Answer 30

Heightened bi-directional resistance to passive movement of the limb (non velocity dependent).

Question 31

what is the cycle for tone

Answer 31

increased spasticity

leads to immobilization and disuse

leads to contracture

this loops

Question 32

what is the impact of tone on function

Answer 32

Ranges from minor effects on the quality of movement to significant difficulties for caregiving and ADL

Question 33

what is the presentation of tone post stroke

Answer 33

U/E Flexor Synergy

Question 34

what are the 3 impacts of impaired sensation

Answer 34

Sensory feedback

Response or urge to move

Functional use even with intact motor function

Question 35

what is Hemiplegic Shoulder Pain

Answer 35

Shoulder pain present at rest or during movements on the hemiparetic side after stroke with no history of trauma or injury

A symptom, not a diagnosis

Question 36

shoulder pain is correlated with what 3 things

Answer 36

loss of external rotation

lack of biomechanical alignment

spasticity

Question 37

what is the expectation of recovery of Hemiparetic UE Function

Answer 37

initially ~30% of stroke survivors have severe UE motor impairments

30-66% have no improvement

25% of partial recovery

5-20% have full recovery